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Journal of Neurosurgical Sciences 2013 June;57(2):123-7


language: English

Minimally invasive transmuscular approach for the treatment of lumbar herniated disc: far lateral lumbar disc herniation: a clinical study. Applications for cervical and thoracic disc herniation

Peltier E., Blondel B., Dufour H., Fuentes S.

Service of Neurosugery, CHU La Timone, Marseille, France


Aim: In this study, we are using a recently developed method: a minimally invasive retractor system and an operating microscope to treat far lateral lumbar herniated disc. This method decreases tissue dissection and blood loss, and improves postoperative recovery.
Methods: This is a retrospective study of 46 patients, there was 25 female and 21 male. They all underwent minimal invasive surgery. The average age was 56 years old (19-83 years). Lumbar disc herniation is a common pathology. Far lateral disc herniation accounts for 2.6% to 11.2% of all lumbar disc herniation. A few surgical techniques have been describes to treat this type of disc pathology. All patients were operated under general anesthesia. The fluoroscopic guidance was absolutely necessary. A 12-15 mm skin incision was made on the side of the disc herniation (30 mm from the midline). Then, we inserted a tubular retractor system (muscle splitting approach) followed by a 14 mm diameter-working channel. Under operating microscope the pars interarticularis was dreamed to expose the nerve root and the disc. After removing the intertransverse ligament, we removed the herniated disc.
Results: The average time of surgery was 55 min. The operating time decreased with the experience of the surgical team. Postoperatively the radicular pain was around 2 (using an analogical visual scale), over 7 preoperatively. The length of hospitalization was 3 days. There were no complications in our study. The average follow-up was 2 years (6-36 months). There was no complication, no postoperative infection.
Conclusion: This technique combines the advantages of endoscopic surgery and microscope guided surgery (3D vision) and provides good functional results in this study.

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